MEDICARE: TRACY E SCHILLER P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9106935	FL
2	363AM0700X	Medical Physician Assistant	002388	IA

General Provider Information

NPI Number	:	1275974081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY E SCHILLER P.A.

Provider Business Mailing Address
First Line	:	3618 LANTANA RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2246
Country	:	US
Telephone Number	:	561-296-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	3618 LANTANA RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2246
Country	:	US
Telephone Number	:	561-296-1188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	06/20/2014

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